Руководство содержит структурированное описание основных сердечно-сосудистых средств, упоминаемых в российских клинических рекомендациях при лечении кардиологических больных. Оно основано на принципах и стандартах доказательной медицины и направлено на совершенствование медицинских знаний в области пациенто-ориентированного подхода, прежде всего врачей первичного звена здравоохранения – врачей-терапевтов и врачей общей практики. Издание будет полезно врачам-кардиологам и кардиохирургам, а также специалистам смежных специальностей – врачам скорой медицинской помощи, реаниматологам, эндокринологам, нефрологам, неврологам, гериатрам. Руководство может быть использовано в качестве учебного пособия для освоения современных подходов к фармакотерапии сердечно-сосудистых заболеваний при подготовке ординаторов и студентов медицинских вузов.

One of the links in the pathogenesis of cardiovascular diseases is chronic low-intensity systemic inflammation. In 2004, a previously unknown process was discovered — the formation of extracellular neutrophil traps (NETs) — NETosis (n eutrophil extracellular traps). NETs play a role in antimicrobial immunity though in certain cases they become a factor in the development of pathology. This review presents data on the effect of extracellular neutrophil traps on individual pathologies of the cardiovascular system (atherosclerosis, atrial fibrillation, thrombosis). The authors describe the mechanisms of NET formation (vital NETosis, suicidal NETosis) and their role in thrombus formation (as a framework for thrombus formation, initiation of coagulation), in the development of endothelial dysfunction, and electrical heterogeneity of the atrial myocardium. Data are presented indicating the connection between atherosclerosis, thrombosis, and atrial fibrillation with the activity of NETosis. Most studies demonstrate existing correlations on laboratory models, while the determination of NETs in patients with cardiovascular pathology in real clinical practice is almost absent. At the same time, understanding the processes associated with NETosis can help to identify specific markers and further strategies for the therapy of cardiovascular diseases.

According to the criteria of internal stability and the measure of consent, questionnaires for a comprehensive assessment of treatment adherence to CAA-25 for pregnant women and legal representatives of patients were evaluated. In a descriptive one-stage study involving 96 pregnant women in Omsk with at least one previously born child, the level of treatment adherence was determined using the CAA-25 questionnaire, using the CAA-25 MB and CAA-25 MH questionnaires, with an assessment of internal stability and consent measures. The CAA-25 MB questionnaire demonstrated good internal stability (α 0.900, ast 0.912) with high reliability (consistent exclusion of scale points preserves the validity of the questionnaire in the range 0.889-0.910), with almost perfect agreement (κ 0.913). The CAA-25 MH questionnaire demonstrated good internal stability (α 0.902, ast 0.922) with high reliability (consistent exclusion of scale points preserves the validity of the questionnaire in the range of 0.884-0.902), with almost perfect agreement (κ 0.909), it is advisable to use the tested questionnaires to assess comprehensive adherence to treatment of pregnant women and legal representatives of patients.

Patients with polyvascular disease (PVD), involving two or more vascular beds, are a difficult group for cardiologists, cardiovascular surgeons and endovascular surgeons. The relevance of the problem is due to its widespread prevalence, rapid progression, and comorbidity, which worsens the prognosis in this cohort of patients. The problem of selecting the optimal revascularization tactics remains unresolved. The results of original research on this problem are analyzed. The need for an individual multidisciplinary approach to determine the best revascularization strategy is demonstrated. The use of various methods of optimal therapy, open and endovascular surgery in each specific case is the most acceptable tactic.

In modern medical practice, the issue of catheter-associated bloodstream infections is becoming more and more relevant, as these infections now account for a significant proportion of all cases of bacteremia among hospitalized patients. This review offers a detailed investigation of various strategies aimed at reducing the incidence of catheter-associated infections, with particular emphasis on methods for which there is robust evidence of efficacy. The impact of changes in problem definition and health care regulation on the dynamics of incidence reduction is analyzed. Particular emphasis is placed on the period covered by the COVID-19 pandemic, discussing the vulnerabilities of some infection prevention strategies identified in the face of health system variability. The focus is on the increased prevalence of catheter-associated infections during the pandemic period. This reveals weaknesses in some existing strategies and highlights the urgent need to develop more flexible and adaptive infection prevention methods, especially in a rapidly changing health care environment. This review provides a comprehensive analysis of the effectiveness of strategies to prevent catheter-associated infections, with attention to their applicability in the variable environment of modern healthcare. The pandemic period emphasizes the need to update the prevention system, with a focus on strategies free from human error and able to adapt to rapidly changing healthcare environments. An important recommendation is the active use of advanced technologies such as antiseptic-impregnated catheters and dressings. This not only ensures system resilience in the face of rapidly changing demands and uncertainty, but can also reduce the risk of infections. The implementation of simplified definitions and electronic automation are put forward as key measures to improve system robustness and effective control of catheter-associated infections in today's dynamic healthcare environment. Thus, this review not only provides an extensive analysis of strategies to prevent catheter-associated infections, but also emphasizes their applicability in today's variable healthcare environment, especially in a pandemic, suggesting specific measures to strengthen the prevention system and ensure stability in a rapidly changing healthcare environment.

Пищевые привычки и диета играют значительную роль в модуляции хронического системного воспаления. Привычки, связанные с питанием, являются многомерными величинами с тесными внутренними корреляциями. Сложность оценки влияния факторов может быть упрощена с помощью диетических индексов, которые количественно оценивают диетические различия в одном показателе и предлагают средства контроля рациона питания в клинических исследованиях. В данной обзорной статье рассмотрены особенности применения различных диетических индексов и вопросников о частоте приема пищи в исследованиях по оценке влияния пищевого поведения на показатели хронического низкоинтенсивного воспаления.

Aim. To provide data on the diagnostic and prognostic value of questionnaire survey for post-COVID-19 syndrome during screening and regular medical check-ups of employees, as well as preventive medical examinations. Material and methods . This single-center cross-sectional comparative study involved 1120 people (92,1% of the general population — all employees of the organization), including 195 men (67,3% of the general population) and 925 women (79,5% of the general population). All participants filled out the post-COVID-19 syndrome (PS) detection questionnaire, the Hospital Anxiety and Depression Scale and the QAA-25p Adherence Assessment Questionnaire. Potential adherence to treatment was calculated using the SCOPA software. Statistical processing was performed using tools adapted for medical and biomedical research (Python language; Sklearn, NumPy, Pandas libraries) and Statistica 6.13 (StatSoft Inc., USA). Results. As a result, 47% of respondents noted at least one symptom that reduces the quality of life and/or performance efficacy. In all subsamples, women reported symptoms more frequently than men. The most informative indicators associated with post-COVID-19 syndrome are age (Mann-Whitney U test, p=0,042), number of PS symptoms (Mann-Whitney U test, p=0,001), severity of PS symptom (Mann-Whitney U test, p= 0,004) and adherence to health care (Kruskal-Wallis H test, p=0,021). An increased level of anxiety is associated with all the analyzed symptoms, depression level with 6 symptoms, age with 5 symptoms, insufficient compliance with 3 symptoms. Conclusion. PS questionnaire should be included in a comprehensive survey program of persons undergoing medical examinations. It is necessary to develop algorithms for the treatment and diagnosis of patients that take into account the number and severity of individual symptoms separately for men and women with consideration to their COVID-19 epidemiological status, as well as age and markers of anxiety, depression, and adherence to treatment.

The study of the causes and mechanisms of symptoms, the study of diagnostic methods and the search for the most effective methods of management of patients with various supraventricular rhythm disturbances have remained highly relevant since the formation of medical science. Previous studies of the structure of cardiac conduction system, physiologic and pathophysiologic processes, introduction and modification of new methods of diagnostics of cardiovascular diseases became the basis for modern algorithms of management of patients with arrhythmias.

РезюмеАктуальность: Распространенность фибрилляции предсердий в современном мире постоянно растет.В большинстве случаев, эта патология встречается у людей пожилого и старческого возраста, что делает ее важной гериатрической проблемой.Несмотря на большое количество исследований, остается много нерешенных вопросов, касающихся патогенеза и терапии фибрилляции предсердий.Цель исследования: Анализ современных данных литературы об этиологии, патогенезе, диагностике и лечению фибрилляции предсердий.Материалы и методы: Анализировались научные работы, находящиеся в открытом доступе в базах данных PubMed, Embase, Web of Science, Elibrary и Google Scholar.Для последующего анализа преимущественно отбирались публикации, вышедшие на английском языке и размещенные, начиная с 1 января 2017 года.Учитывались имеющиеся в публикациях ссылки на ранее опубликованные работы.Поиск литературных источников производился по следующим ключевым словам: фибрилляция предсердий, прямые оральные антикоагулянты, катетерная абляция, генетика.При анализе литературных данных особое внимание уделялось систематическим обзорам и метаанализам результатов научных исследований.Результаты: В обзоре представлены современные данные о влиянии воспаления и состояния вегетативной нервной системы на развитие фибрилляции предсердий, большое внимание уделено роли генетических факторов в ее развитии.Уделено внимание особенностям медикаментозной терапии у пожилых.Сопоставлены эффективность различных подходов к лечению фибрилляции предсердий, обращено внимание на возможные перспективы дальнейших

Современный образ жизни в развитых странах оказывает значительное влияние на склонность организма человека к метаболическим нарушениям, а следовательно, к целому ряду хронических неинфекционных заболеваний. Зачастую в основе таких расстройств лежит хроническое низкоинтенсивное воспаление, вызванное активацией различных молекулярных путей, таких как ядерный фактор каппа-би (NF-κB), митоген-активируемая протеинкиназа (MAPk), рапамициновый комплекс 1 (TORC1), циклооксигеназа-2 (COX-2). Многочисленные интервенционные исследования показали, что изменение образа жизни способствует уменьшению воспаления и улучшению показателей здоровья. Это можно связать с концепцией моделирования рисков в реальной жизни, поскольку человек постоянно подвергается воздействию диетических факторов в небольших дозах и сложных комбинациях (например, полифенолов, клетчатки, полиненасыщенных жирных кислот). Сбалансированная диета в сочетании с ограничением калорийности модулирует молекулярные механизмы, такие как m-TOR, NRF2, IKK/JNK, JAK/STAT, что в конечном итоге приводит к значительному снижению уровня маркеров воспаления, а также к улучшению метаболических показателей. Переход к более здоровому питанию на индивидуальном уровне и в государственных учреждениях может улучшить популяционное здоровье, снизить финансовую нагрузку на систему здравоохранения и повысить устойчивость общества к эпидемиям, которые в основном поражают людей с метаболическими заболеваниями.

The term "microbiota" refers to the microbial community occupying a specific habitat with defined physical and chemical properties and forming specific ecological niches. The adult intestinal microbiota is diverse. It mainly consists of bacteria of Bacteroidetes and Firmicutes types. The link between the gut microbiota and cardiovascular disease (CVD) is being actively discussed. Rapid progress in this field is explained by the development of new generation sequencing methods and the use of sterile gut mice in experiments. More and more data are being published about the influence of microbiota on the development and course of hypertension, coronary heart disease (IHD), myocardial hypertrophy, chronic heart failure (CHF) and atrial fibrillation (AF). Diet therapy, antibacterial drugs, pro-and prebiotics are successfully used as tools to correct the structure of the gut microbiota of the macroorganism. Correction of gut microbiota in an experiment on rats with coronary occlusion demonstrates a significant reduction in necrotic area. A study involving patients suffering from CHF reveals a significant reduction in the level of uric acid, highly sensitive C-reactive protein, and creatinine. In addition to structural and laboratory changes in patients with CVD when modifying the microbiota of the gut, also revealed the effect on the course of arterial hypertension. Correction of gut microbiota has a beneficial effect on the course of AF. We assume that further active study of issues of influence and interaction of gut microbiota and macroorganism may in the foreseeable future make significant adjustments in approaches to treatment of such patients.

Aim. To assess the adherence of doctors and patients to anticoagulant therapy for atrial fibrillation (AF).Materials and methods. An observational prospective study included 99 patients with AF at high risk of thromboembolic complications in Ryazan and Omsk. To study adherence, a questionnaire for quantitative assessment of treatment adherence ("QAA-25") was used. The questionnaire allows you to assess adherence by three main parameters separately: adherence to drug therapy, lifestyle modification and medical support. For the purposes of the study, adherence rates of less than 75% were regarded as insufficient, 75%. % or more as sufficient. To assess food preferences and determine the risk of changes in the activity of warfarin, a questionnaire of food preferences was used. The questionnaire allows you to assess the risk of alimentary increase (≥30 points) and decrease (≥60 points) of warfarin activity, as well as the overall risk of alimentary change (≥90 points) of warfarin activity in each patient, taking into account the volume and frequency of consumption of products that affect the activity of warfarin.Results. After the first visit, 99% of respondents received anticoagulant treatment. Rivaroxaban was the leader in prescribability among anticoagulants (36.7%). About a third of respondents were prescribed apixaban by a doctor (30.6%) and dabigatran (17.3%) and warfarin (19.4%) were prescribed almost twice as rarely as rivaroxaban. Respondents with the highest rates of adherence to drug therapy, lifestyle modification and medical support are AF patients taking apixaban. The respondents who were prescribed rivaroxaban had the lowest level of adherence to drug therapy and lifestyle modification. And the lowest level of commitment to medical support is among respondents who have been prescribed warfarin. The number of people with a sufficient level of commitment did not reach half. Only 43.9% were ready to take prescribed medications and slightly more than a third (34.7%) agreed to come to appointments for a long time. But, despite the importance of lifestyle modification in patients with AF, only 16.3% of respondents said they were ready to give up bad habits, lose weight and lead a more active lifestyle. The proportion of people with sufficient adherence to drug therapy was the smallest in the group taking rivaroxaban (25.7%). The least number of respondents with sufficient commitment to medical support in the group taking dabigatran (25%). Only one in ten patients (11.1%) taking warfarin had a sufficient level of commitment to lifestyle modification. 15% of the study participants had an increased risk of alimentary changes in the activity of warfarin.Conclusion. Assessment of adherence to anticoagulant therapy by doctors in two regional centers (Omsk and Ryazan) showed high prescribability of preventive antithrombotic therapy, which corresponds to modern therapeutic approaches. At the same time, patients demonstrated rather low levels of adherence to drug therapy, lifestyle modification, and medical support.

Фибрилляция предсердий (ФП) является наиболее распространенной аритмией и встречается у 0,1—18% взрослых. Несмотря на большое количество исследований до сих пор остаются нерешенными вопросы относительно механизмов развития ФП. В обзоре представлены данные о наличии связи между нарушениями кишечной микробиоты и различными формами ФП. Триллионы микроорганизмов, населяющих желудочно-кишечный тракт, превращают питательные вещества в активные метаболиты (триметиламин-N-оксид, короткоцепочечные жирные кислоты и др.), которые обеспечивают взаимодействие с макроорганизмом. В работе рассмотрены новейшие данные об эффективности диеты (воспалительный индекс (dietary inflammatory index, DII), значение функциональных связей между диетой, кишечной микробиотой, ее метаболитами и макроорганизмом. Несмотря на существенный прогресс в изучении ФП, необходимы дальнейшие исследования для уточнения связи микробиоты кишечника и механизмов ФП, создания прогностических биологических и вычислительных моделей, определения надежных биомаркеров риска развития данной патологии.

In Russia, the QAA-25 questionnaire is used to quantify the adherence to treatment of adult patients. The accumulated experience of its use made it possible to identify several cohorts of respondents, including adolescents, whose characteristics required special adaptation of the formulations of a number of questions. Purpose . The study aimed at modifying the questionnaire for quantitative assessment of treatment adherence QAA-25 for adolescents aged 15–17 years and evaluate it according to the criteria of validity and the measure of consent. Material and methods . In a descriptive one-stage study with the participation of 108 high school students at secondary schools in Omsk, the level of adherence to treatment was determined according to the QAA-25 scale, using traditional and alternative formulations of individual questions, with the formation of a modified scale and an assessment of its constructive and factor validity and a measure of consent. Results . Applying various options for testing alternative questions, the possibility and expediency of using them to assess the adherence to treatment of adolescents, including separately evaluated subsamples of male and female individuals, was shown. 94% of respondents rated alternative questions as “more acceptable,» 5% of respondents «did not notice significant differences,» and 1% of respondents rated them as «less acceptable.» The QAA-25 scale modified for adolescents demonstrated good structural and internal validity (α = 0.818, α st = 0.857), with high reliability (consistent exclusion of scale items preserves the validity of the questionnaire in the range of 0.793–0.858) and almost perfect agreement (κ = 1.000). Conclusion . The modified QAA-25 questionnaire is recommended to be used to assess the adherence to treatment and potential adherence to treatment of adolescents who have reached the age of 15 but have not reached the age of 18, both for research purposes and when making decisions related to the provision of medical care and the organization of preventive measures.

Выявление отягощенной наследственности, жалоб и симптомов, обусловленных рядом социально значимых неинфекционных заболеваний, является важной задачей, которая должна быть решена при проведении обязательных и профилактических медицинских осмотров, а также диспансеризации. В России разработана анкета для профилактического медицинского осмотра и диспансеризации, но отсутствует анкета для обязательных медицинских осмотров. Кроме того, до сих пор не разработаны и не унифицированы инструменты анкеты, предназначенные для оценки тревоги и депрессии, приверженности лечению, возрастных факторов риска, постковидного синдрома, и ряд других. Это создает трудности, связанные как с единообразным подходом выявления факторов риска социально значимых неинфекционных заболеваний при проведении медицинских осмотров различного уровня, так и с универсальной интерпретацией полученных при анкетировании результатов. Работа посвящена созданию унифицированной анкеты для выявления отягощенной наследственности, жалоб, симптомов, характерных для неинфекционных заболеваний и состояний, при проведении обязательных предварительных и периодических медицинских осмотров работников, а также профилактических медицинских осмотров и диспансеризации.

The study objective is to examine the structure and characteristics of secondary employment of medical university students. The authors carry out a survey of students of Omsk State Medical University of the Ministry of Health of Russia by continuous questionnaire survey technique. The questions of the questionnaire were aimed at socio-demographic identification of students. 2 330 (59,6 %) respondents participated in the survey of 3 906 students studying in the organization. According to the survey results 24,7 % (576) of students of OSMU work in their free time, while 12,6 % (294) work in medical sphere. Employed students are more common among married respondents compared to unmarried ones (55,9 and 29,1 % respectively, χ2 = 55.53, p < 0.001, Pearson). There is a growing trend in the proportion of employed students from the 1st year to 5th year (11,9 and 41,8 %, respectively). The same dynamics is revealed in the proportion of employed respondents in medicine (4,4 and 28,8 %, respectively). Respondents studying at the Preventive Medicine Department are employed in the medical field significantly less likely than other departments (χ2 = 30,04, p < 0.001, Pearson). The share of employed OSMU students increases while moving up the educational ladder. At the same time, employed students are 2 times more common among married students. The proportion of employed students of the Faculty of Dentistry of the 3rd and 5th yersis much higher compared to other faculties. Medical and Preventive Faculty students show the lowest rates with respect to employment in the medical field in their free time.

The association of non-alcoholic fatty liver disease (NAFLD) and cardiovascular risk is currently one of the actively studied areas. The incidence of non-alcoholic fatty liver disease continues to grow worldwide. In the structure of mortality rate of patients with non-alcoholic fatty liver disease, the first place is occupied by cardiovascular events: stroke and myocardial infarction. Studies have shown that the presence of severe liver fibrosis (F3-4) in NAFLD not only increases the risk of cardiovascular diseases (CVD), but also increases the risk of overall mortality by 69% due to mortality from cardiovascular causes. The degree of increased risk is associated with the degree of activity of non-alcoholic steatohepatitis (NASH). Despite the large number of works on this topic, we do not have a clear opinion on the impact on cardiovascular risk, interaction and the contribution of various factors, as well as algorithms for managing patients with non-alcoholic fatty liver disease to reduce the risk of cardiovascular diseases. This article describes the pathogenetic factors of formation of cardiovascular risks in patients with non-alcoholic fatty liver disease, proposed the idea of stratification of cardiovascular risks in these patients, taking into account changes in the structure of the liver (fibrosis) and function (clinical and biochemical activity) and also it describes the main directions of drug therapy, taking into account the common pathogenetic mechanisms for non-alcoholic fatty liver disease and cardiovascular diseases. The role of obesity, local fat depots, adipokines, and endothelial dysfunction as the leading pathogenetic factors of increased cardiovascular risk in patients with NAFLD is discussed. Among pathogenetically justified drugs in conditions of poly and comorbidity, hypolipidemic (statins, fibrates), angiotensin II receptor antagonists, beta-blockers, etc. can be considered. According to numerous studies, it becomes obvious that the assessment of cardiovascular risks in patients with NAFLD will probably allow prescribing cardiological drugs, selecting individualized therapy regimens, taking into account the form of NAFLD, and on the other hand, building curation taking into account the identified cardiovascular risks.